District Health Centre:
Funded by the Government, District Health Centre (DHC) operates through district-based medical-social collaboration in community to provide services in health promotion, health assessment, chronic disease management, community rehabilitation, etc.
Community Rehabilitation Programme – hip fracture (CRP-hip fracture):
Tertiary prevention programme for hip fracture is targeted for patients discharged from hospitals who have completed acute, subacute or day rehabilitation programme. Patients with more dependence in ambulation (MFAC II-V) require higher intensity of training and support for their carer. Patients with higher ambulatory level (MFAC VI- VII) may benefit from empowerment/exercise programmes.
CRP-hip fracture involves multi-disciplinary team (including nurse, physiotherapist, occupational therapist, dietitian, pharmacist, and social worker) as referred by medical doctor in hospital of the district. After receiving the electronic referral, the staff in DHC will contact the patient. Supportive transportation service is available for wheelchair users. Patients have to pay a subsidized fee for consulting physiotherapist, occupational therapist or dietitian with a maximum of 8 sessions while free consultations for other disciplines are arranged. Besides, there are education and exercise classes available to promote safe and active engagement in community.
Progress:
From 2020, there were 180 hip patients enrolled into CRP-hip fracture in K&TDHC with 129(71.7%) completed and 51(28.3%) defaulted. The mean age was 81.7(SD 8.3) and average attendance was 6.7(SD 2.3) sessions. Before CRP, 60.5% of patients had to support with frame/rollator and lower to 39.5% afterwards. Use of one-sided support of aid (quadripod/stick) was 27.8% before and increased to 40.0% afterwards. Only four patients (2.2%) could walk unaided before and later 22(12.2%) patients. Before CRP, 58.4% patients walked with assistance. After CRP, 67.3% patients could walk independently. Besides there was significant improvement observed in mobility [EMS mean(SD) increase 2.45(2.56) points, p-value 0.000], balance [TUG mean(SD) decrease 14.53(19.04) seconds, p-value 0.000], modified Barthel Index [mean(SD) increase 6.41(6.65) points, p-value 0.000].
Conclusion:
CRP-hip fracture enabled the hip patients and their carers to cope with barriers to re-integrate into community after hospital discharge, which is especially important in the early stages. The patients acquired higher level of independence in mobility and better control of fall risk.
